Our EAP Provider Network

Participating with Mazzitti & Sullivan EAP will help you build up or sustain your practice while allowing us to offer a wider variety of agencies to our clients. We are always expanding our national network of EAP providers and welcome qualified counselors to submit their application and W-9 for consideration. Our main requirements for participation in our EAP network include maintaining liability coverage in the amounts of $1 million (individual) and $3 million (aggregate), and either having a state-issued license or working under a licensed counselor.

Become an EAP Provider

Please download and complete the New Provider Application Packet below, along with your W-9 tax ID form, to be considered for our network of EAP counselors. This packet contains all the forms you will need to complete and send back to us.

Completed applications with supporting licensure, liability, and tax documentation can be submitted via email to [email protected].A Mazzitti & Sullivan EAP staff member will be in touch with you once we have received your information. Please call 1-800-543-5080 or email us anytime if you have questions about becoming a provider in our EAP network. You may view an informational video on YouTube regarding our introductory Provider Paperwork.

For Current Providers

If you are a participating provider with us currently and would like to add a new location or update your existing contact information, please fill out a new Agency Information sheet below. A new W-9 form is also required for updates that affect the payee’s name or address information. For participating providers wishing to add a new counselor to the EAP roster, please complete the Counselor Information document below and email it to [email protected], along with copies of the counselor’s liability coverage and license (or indicate if they are working under a licensed clinician). If the clinician is going to be paid directly, we will also need a completed W-9 form.

How it Works

We strive to keep paperwork to a minimum and do all we can to make the referral process easy for our clients and providers. We only require a client Consent to be Treated, which can be uploaded online when you enter your invoices through our Provider Portal. To receive access to the Portal, please complete the Provider Portal Agreement and return to us at [email protected] or by faxing to 717-561-1125.

To learn more about the Provider Portal, please view our Frequently Asked Questions page. For an informational overview regarding our Paperwork and Invoicing processes, please visit our YouTube channel and let us know if you have any questions!

Clients must sign a Consent Form if they are to receive services through the EAP. We can also accept other Consent forms, if necessary, but would appreciate it if you would furnish our Notice of Privacy Practices to the client.  We must receive a copy of a Consent to be Treated (your own or ours) before we can process payment. Verbal or digital consents may be noted on the signature line as such, and the form may be faxed or emailed to our office or submitted through the Provider Portal.

These forms are “fillable” PDFs that can be edited using Adobe Acrobat (a free download) and may be emailed to [email protected] within 14 days after the date of service. We encourage interim billing! Please contact the EAP staff (call 1-800-543-5080 or email [email protected]) if you have an invoice that is greater than 14 days old to request an exception.

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